In severe cases of lipedema, the costs for liposuction will be covered by the statutory health insurance companies from January 2020. The National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds (GKV) have added several new fee order items to the EBM (German Uniform Evaluation Standard) and set the reimbursement.
The liposuction, suction of the pathological fat tissue, aims to improve the mobility and thus alleviate the symptoms, often in several partial interventions. However, operative liposuction of lipedema in stage III can only be carried out if conservative therapy has not previously relieved the symptoms. This must have been carried out for at least six months and can include, for example, lymphatic drainage, compression, movement therapy.
The operation can then be performed and reimbursed on an outpatient basis or by a contracted doctor. The doctors will be billed up to 763€ per procedure. The costs for local anesthesia and the suction cannula used will be reimbursed additionally. Reimbursement will be procured via the following fee order items (GOPs), added to the EBM as of January 1, 2020:
- 31096/36096 Liposuction for stage III lipedema (category AA6 intervention) with a tariff of 663,29€/419.93€
- 31097/36097 Liposuction for stage III lipedema (category AA7 intervention) with a tariff of 708,01€/452.45€
- 31098/36098 Surcharge for GOP 31096/36096 for simultaneous interventions and for GOP 31097/36097 with a tariff of 67.24€/41.42€
- 31802/36802 Tumescent local anesthesia performed by the surgeon with a tariff of 284.79€/177.88€
- 40165 The suction cannula (s) used during the procedure according to the GOP 31096 and 31097 with a tariff of 72.00€.
Doctors who want to perform liposuction for stage III lipedema require an outpatient surgery permit (in accordance with §135 paragraph 2 SGB V) and should be experienced in the treatment of lipedema.
The basis for liposuction reimbursement is the decision of the Federal Joint Committee (G-BA) of September 19, 2019. The inclusion of the method is initially limited to December 31, 2024, since the results of the trial initiated by the G-BA on liposuction in lipedema are expected to be ready by that date. As soon as the study results are available, the G-BA will finally decide on the method for all stages of the disease.
The full details in German can be found here.
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